Provider Demographics
NPI:1972804375
Name:4 HIS MAJESTY BEAUTY SUPPLY
Entity Type:Organization
Organization Name:4 HIS MAJESTY BEAUTY SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:192-584-1758
Mailing Address - Street 1:2230 HILLTOP MALL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1924
Mailing Address - Country:US
Mailing Address - Phone:925-584-1758
Mailing Address - Fax:510-223-8845
Practice Address - Street 1:2230 HILLTOP MALL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1924
Practice Address - Country:US
Practice Address - Phone:925-584-1758
Practice Address - Fax:510-223-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40013907332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment